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Dear Parent / Guardian

Year 11 Earth and Environmental Science Excursion 1


An off-site learning activity has been organised for Year 11 Earth and Environmental Science
students. On Wednesday March 25 (Week 8) we will be visiting Freshwater Bay to study the
sedimentary rock formations before viewing the exhibit at the UWA Earth Sciences
museum.
Please complete and return the attached medical and permission forms to Mrs Lane in the
Administration office and payment of $11 in the attached envelope by Monday 23th March
2015.
Students are to bring their own lunch and drinks as there will be no opportunity to buy food
or drink.
If you require any further information please contact us on
9445 4338 or jmatthews@churchlands.wa.edu.au for Mr James Matthews
or
9445 4478 rharris@churchlands.wa.edu.au for Mr Roger Harris
Date: Wednesday March 25
Time: 9.00 am 3.15 pm
Transport: CSHS bus
Dress: school uniform tops required (respectable shorts or jeans are fine)
Cost: $11
Staff: Mr Matthews and Mr Harris
Students will need to bring their own lunch and drinks as there will be no opportunity to buy
food or drink.
Please contact us at school via email or phone if you require any further information.
Yours sincerely
James Matthews and Roger Harris
Earth & Environmental Science Teachers
17th March 2015

Year 11 Earth & Environmental Science Excursion 1 Itinerary


Itinerary:
9 am

Leave CSHS

9.30 11.30 am

Freshwater Bay

11.30 12 pm

Lunch

12.30 2.45 pm

UWA Earth Sciences Museum

2.45 3.15 pm

Return to CSHS

What to Bring:
School uniform tops with shorts or jeans
Bring food and drinks for lunch. There will be no opportunity to purchase
food or drinks at both of the sites we visit.
A clip board to lean on, paper, pens and pencils.
A bag or back pack for these items.

Note: you will be required to complete an information sheet during the excursion and a validation
test early in Week 9

PARENT/GUARDIAN CONSENT & STUDENT HEALTH FORM

For Year 11 EES Excursion to be returned to school by Monday 23/03/15.

I am aware that any costs incurred as a result of accident or illness are my responsibility and that
school staff are not responsibility for any loss or damage to my childs personal property that may
occur during the course of the excursion.
I agree to inform the organisers well before the scheduled excursion departure of any change to my
childs health and fitness so that appropriate supervision may be arranged.
I acknowledge that, should it be considered necessary, school staff will arrange to present my child
for medical assessment and treatment.
Please fill in your contact details in the spaces below:

Home:

Work:

Mobile:

Other contact information:


I have read and understood the information regarding the Year 11 EES Excursion on
25/03/15 and give my consent for my son/daughter: _________________________
to attend this excursion.

Date of Birth: ____________

Parent/Guardians full name: __________________________________________


Address: ________________________________________ Postcode: ________
Signature of parent/guardian: ______________________ Date: ______________

STRICTLY CONFIDENTIAL
This information, which is required for each student participating on the Year 11 EES Excursion 1 2015, will assist the school and supervising
teachers in the preparation and planning of an excursion.

Student details
Students name

Date of birth

Parents full name


Address

Postcode

Home Telephone No __________________

Mob ____________________________

Emergency Contact phone and name; __________________________________________________________________________


Name of family doctor
Telephone
Medical details
Is your child subject to seizures, fainting, epilepsy, diabetes or any other condition that may affect his or her safety during the excursion?
Yes

No

Details:
(Attach additional Info if required)

Special Dietary requirements: _________________________________________________________________________________


Is your child allergic to:
Penicillin
Any other drug
Any food
Other

Details
Details
Details
Details

Date of last tetanus vaccination:


Medication
Parents are requested to make arrangements with the teacher-in-charge for the safekeeping and handling of medications prior to the excursion.
Students should carry with them any medication e.g. for asthma or allergies that they require.
Staff are not permitted to give analgesics (painkillers).
Is your child presently taking tablets and/or other forms of medication?

Yes

Does your child self-administer the medication?

Yes

No
No

If "yes", state name of medication, dosage and frequency of use:

Other information
Please provide any other information that will enable the organisers of the excursion to provide better care for your child.

CONSENT

I agree to inform the organisers before the scheduled excursion departure of any change to my childs health and
fitness so that appropriate supervision may be arranged. I acknowledge that, should it be considered necessary,
school staff will arrange to present my child for medical assessment. I am aware that any costs incurred as a result of
accident or illness are my responsibility and that the school staff are not responsible for any loss or damage to my
childs personal property that may occur during the course of the excursion.
I have read and understood this information regarding the Year 11 EES Field Excursion Semester 1, 2015 and give
permission for my child to attend.
Signature of parent

Date

To be returned to Mr Matthews or Mr Harris in the Science Office by Monday 23rd March